MODULE - 1 OVERVIEW OF MEDICARE PROGRAM BASICS

Question 1

What is Medicare?

Answer 1

• Medicare is the Federal health insurance program for individuals who are aged (65 and over and younger individuals who have certain health conditions or are disabled.
• Medicare eligibility does not take into consideration an individual’s income.
  However,
  –individuals may pay higher premiums based on income, and
  –low-income individuals may be eligible for additional assistance.
• individuals can receive their Medicare medical coverage:
  – directly from the Federal Government, which pays for services on a fee-for-service basis (this program is known as “Original Medicare” or “Fee-for-Service Medicare”); or
  – through a private health plan.
• Individuals must receive their Medicare Part D outpatient drug benefits through a private health plan (even if they get their medical coverage through Original Medicare).

Question 2

Parts of Medicare Coverage:

Answer 2

– Part A is referred to as “Hospital Insurance Benefits.” Part A also covers other inpatient care, including skilled nursing facilities, rehabilitation facilities, and hospice.

– Part B is referred to as Supplementary Medical Insurance Benefits.” Part B covers a broad range of outpatient services such as physician care, and drugs that are administered by physicians or other health care professionals (such as certain vaccines and intravenous medications).

– Part C regulates and authorizes Medicare Advantage plans, which must cover Part A (except for hospice) and Part B benefits.
Individuals enrolled in a Part C plan still get hospice benefits, but they are paid for by Original Medicare.

– Part D covers prescription drug benefits (for self-administered drugs, such as those picked up at a pharmacy and taken at home) and regulates Medicare prescription drug plans.

Question 3

What is Medicare Part E?

Answer 3

– There is also a lesser-known Part E of Medicare law that regulates other miscellaneous programs including:
- Medicare cost plans (which also cover Part A and Part B benefits)
Medicare cost plans are only offered in a limited number of states and are most frequently found in rural areas.
– Medicare supplemental insurance (Medigap Plans)
– The Program for All-inclusive Care for the Elderly (PACE)

Question 4

Different Ways to Get Medicare:

Answer 4

There are different ways that beneficiaries can choose to receive their Medicare coverage.
– Original Medicare (Part A and Part B coverage)
- Can be combined with a Medicare Supplement Plan and/or a Medicare Prescription Drug Plan.
– Medicare Advantage Plans (Medicare Part C health plans, with or without Part D benefits)
– Medicare Prescription Drug Plans
– Medicare Cost Plans
– PACE Plans
– Medicare-Medicaid Plans